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Women’s Health > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What is the first line treatment for pregnant women with vaginal thrush?

A

Clotrimazole pessary - as oral antifungals are contraindicated as they may be associated with congenital abnormalities.

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2
Q

What are two key side effects of progesterone depot injection?

A

Weight gain and reduced bone mineral density (osteoporosis).

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3
Q

How long before major elective surgery should oestrogen contraceptives be discontinued?

A

4 weeks before.

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4
Q

How long after giving birth do women become fertile again?

A

21 days

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5
Q

When can postpartum women (breastfeeding and non-breastfeeding) start the POP?

A

At any time postpartum.

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6
Q

Why should the COCP not be used in the first 21 days postpartum?

A

Due to increased risk of VTE.

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7
Q

Is the COCP safe to use whilst breastfeeding?

A

No - it is an absolute contraindication (UKMEC 4) < 6 weeks postpartum.

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8
Q

When can the IUD or IUS be inserted after giving birth?

A

Within 48 hours of childbirth or after 4 weeks.

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9
Q

Describe the UK Medical Eligibility Criteria (UKMEC) for contraception

A
  • UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method.
  • UKMEC 2: advantages generally outweigh the disadvantages.
  • UKMEC 3: disadvantages generally outweigh the advantages.
  • UKMEC 4: represents an unacceptable health risk.
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10
Q

What is the recommended contraception for epileptics taking phenytoin, carbamazepine, barbiturates, primidone, topiramate or oxcarbazepine?

A

Depo-Provera, IUD, IUS

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11
Q

What is the recommended contraception for epileptics taking lamotrigine?

A

POP, implant, Depo-Provera, IUD, IUS

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12
Q

Where should the implant be inserted?

A

Subdermal, non-dominant arm.

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13
Q

What is a common side effect of the implant?

A

Unscheduled bleeding - may be managed by a 3 month course of COCP.

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14
Q

A 32-year-old woman presents to a sexual health clinic for contraception advice.

She takes the combined oral contraceptive pill (COCP) as contraception, with a 7 day pill-free interval per month. She started her pill-free interval on the 3rd day of the month and then started taking her pill again on the 10th day of the month. It is now the 14th day of the month and she realises that she forgot to take her pill on both the 12th and 13th day of the month but has taken it today.

She last had unprotected sexual intercourse on the 11th of the month. She strongly does not wish to become pregnant.

What should she be advised?

A

To take emergency contraception - if 2 pills are missed in week 1, consider emergency contraception if she had unprotected sex during the pill-free interval or week 1.

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15
Q

A 17-year-old girl presents to the GP. She is taking the combined oral contraceptive pill and believes she has missed a dose. She last took the pill 3 days ago. She started the current pack 19 days ago. There has been no unprotected sexual intercourse over the last month.

What advice do you give the patient?

A

Finish the pills in the current pack and start the new pack the next day - if 2 pills missed in week 3, finish the pills in the current pack and start new pack immediately, omitting pill-free interval.

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16
Q

Which strains of HPV are responsible for genital warts?

A

6 & 11

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17
Q

How long does it take for contraceptives to be effective if not started on women’s period?

A
  • Instant: IUD.
  • 2 days: POP.
  • 7 days: COCP, injection, implant, lUS.
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18
Q

Older women that are amenorrhoeic (no periods) when taking progestogen-only contraception should continue until either:

A
  • FSH blood test results are above 30 IU/L on two tests taken six weeks apart (continue contraception for 1 more year).
  • 55 years of age.
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19
Q

What other combined methods of contraception are there other than the COCP?

A
  • Contraceptive transdermal patch. Applied and changed every 7 days over a period of 3 weeks (21 days in total) and then patch removed for 7 patch-free days (withdrawal bleed). Can be used whilst bathing and swimming.
  • Contraceptive vaginal ring. Inserted into vagina for 21 days and removed for 7 days.
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20
Q

Why is the progestogen-only injection only 94% effective with typical use?

A

Because women may forget to book in for an injection every 12 to 13 weeks.

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21
Q

What is Noristerat?

A

An alternative to the DMPA that contains norethisterone and works for eight weeks. This is usually used as a short term interim contraception (e.g. after the partner has a vasectomy) rather than a long term solution.

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22
Q

Why is the depot injection associated with osteoporosis?

A

Oestrogen helps maintain bone mineral density in women, and is mainly produced by the follicles in the ovaries. Suppressing the development of follicles reduces the amount of oestrogen produced, and this can lead to decreased bone mineral density.

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23
Q

Where problematic bleeding persists with depot injection, what alternative causes should be excluded?

A
  • STIs
  • Pregnancy
  • Cervical screening
24
Q

Investigations for an impalpable implant?

A

Ultrasound or X-ray to locate.

25
Q

Management of actinomyces-like organisms incidentally found during smear tests in women with a coil?

A

These do not require treatment unless they are symptomatic. Where the woman is symptomatic (e.g. pelvic pain or abnormal bleeding), removal of the intrauterine device may be considered.

26
Q

Why are oestrogen containing contraceptives contraindicated for transgender males taking testosterone?

A

Because oestrogen can antagonise the effect of testosterone.

27
Q

Can levonorgestrel and ulipristal be used more than once in a menstrual cycle?

A

Yes

28
Q

What are the 2 key indications for emergency contraception?

A
  • UPSI.
  • Failed contraceptive methods.
29
Q

When does ovulation occur?

A

14 days before end of menstrual cycle.

30
Q

Is sterilisation permanent?

A

Sterilisation should be considered permanent because reversal success rates are low. NHS doesn’t provide reversal procedures.

31
Q

Is the Depo-Provera injection affected by enzyme-inducing drugs?

A

No

32
Q

For patients assigned male at birth treated with oestradiol, GNRH analogs, finasteride or cyproterone, can this be used as contraception?

A

No - there may be a reduction or cessation of sperm production but it cannot be relied upon as a method of contraception.

33
Q

A 34-year-old female presents to her GP for advice regarding contraception. She recently began seeing a new partner following a divorce and wants to begin the combined oral contraceptive pill. Her body mass index is 32 kg/m² and she is an ex-smoker, previously smoking 20 per day quitting 2 years previously. Her medical history is significant for frequent migraines as a teenager with no preceding aura, factor V Leiden disease and gestational hypertension during the pregnancy of her 2-year-old daughter. Which element of her history is the most significant contraindication to the combined oral contraceptive?

A

Factor V Leiden - increases risk of blood clots.

34
Q

Describe the function of lactobacilli in vaginal flora

A

Produce lactic acid creating an acidic environment (vaginal pH < 4.5) to prevent overgrowth of other bacteria.

35
Q

Describe the signs on a speculum examination for BV

A

Thin, white/grey vaginal discharge and rest of examination usually normal. Any lesion or inflammation warrants further investigation,

36
Q

Treatment of BV in pregnant women?

A

Oral metronidazole - same as non-pregnant women.

37
Q

Describe the complications of BV

A
  • Increase risk of catching STIs e.g. chlamydia, gonorrhoea and HIV.
  • Pregnancy: miscarriage, preterm delivery, PROM, chorioamnionitis, low birth weight and postpartum endometritis.
38
Q

Chlamydia commonly co-infects with which other STI?

A

Gonorrhoea

39
Q

Which subspecies of C.trachomatis causes the classical urogenital chlamydia infection?

A

Serovars D-K

40
Q

Name 2 types of swabs used for sexual health testing

A
  • Charcoal swabs.
  • Nucleic acid amplification test (NAAT) swabs.
41
Q

Describe the purpose of charcoal swabs

A
  • Allows for microscopy (gram staining), culture and sensitivities.
  • Used for endocervical swabs and high vaginal swabs (HVS).
  • Can confirm the presence of: BV, candidiasis, gonorrhoea (endocervical), Trichomonas vaginalis (posterior fornix swab), group B streptococcus.
42
Q

Which organisms does NAAT test for?

A

Chlamydia and gonorrhoea.

43
Q

List some complications of chlamydia

A
  • Pelvic inflammatory disease
  • Chronic pelvic pain
  • Infertility
  • Ectopic pregnancy
  • Epididymo-orchitis
  • Conjunctivitis
  • Lymphogranuloma venereum
  • Reactive arthritis
44
Q

List some complications of chlamydia in pregnancy

A
  • Preterm delivery
  • Premature rupture of membranes
  • Low birth weight
  • Postpartum endometritis
  • Neonatal infection (conjunctivitis and pneumonia)
45
Q

Name some complications of gonorrhoea

A
  • Pelvic inflammatory disease
  • Chronic pelvic pain
  • Infertility
  • Epididymo-orchitis
  • Prostatitis
  • Conjunctivitis (including gonococcal conjunctivitis in a neonate contracted from mother during birth)
  • Urethral strictures
  • Disseminated gonococcal infection
  • Skin lesions
  • Fitz-Hugh-Curtis syndrome
  • Septic arthritis
  • Endocarditis
46
Q

Endometritis

A

Inflammation of the endometrium

47
Q

Salpingitis

A

Inflammation of the fallopian tubes

48
Q

Oophoritis

A

Inflammation of the ovaries

49
Q

Parametritis

A

Inflammation of the parametrium (connective tissue around the uterus)

50
Q

Genital herpes also co-infects with which other virus?

A

HIV

51
Q

Describe symptoms of congenital syphilis

A

Saddle nose, rashes, fever and failure to gain weight.

52
Q

What is the most common genital ulcerative disease?

A

Herpes simplex

53
Q

Cause of multiple deep painful ulcers with a purulent base?

A

Chancroid

54
Q

Cause of a single painless ulcer

A

Chancre - syphilis

55
Q

What’s the other name for Pediculosis pubis?

A

Pubic lice

56
Q

Characteristic symptom of Pediculosis pubis?

A

Pruritus

Women’s Health (5 decks)

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